Reaching the third 95 using community ART delivery models

2021 ◽  
Author(s):  
Mwangelwa Mubiana-Mbewe
Keyword(s):  
Community Art ◽  
The Third ◽  
Delivery Models ◽  
Art Delivery

scholarly journals Simplified ART Delivery Models Are Needed for the Next Phase of Scale Up

PLoS Medicine ◽  
2011 ◽  
Vol 8 (7) ◽  
pp. e1001060 ◽  
Author(s):  
Nathan Ford ◽  
Edward J. Mills
Keyword(s):  
Scale Up ◽  
Delivery Models ◽  
Art Delivery

Learning in the third age: drawing wisdom from reflective stories in community art education

2018 ◽  
Vol 37 (3) ◽  
pp. 283-296
Author(s):  
Dustin Garnet ◽  
Anita Sinner ◽  
Cindy Walker ◽  
Ranya Esmat ◽  
Seonjeong Yi
Keyword(s):  
Art Education ◽  
Community Art ◽  
Third Age ◽  
The Third

scholarly journals Factors that Influence Satisfaction of People Living with HIV(PLHIV) with Differentiated ART Delivery Models in East Central Uganda: A Cross-Sectional Study

2021 ◽  
Author(s):  
Keith Baleeta ◽  
Augustin Muhwezi ◽  
Nathan Tumwesigye ◽  
Betty Nsangi Kintu ◽  
Sara Riese ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Service Delivery ◽  
Cross Sectional Study ◽  
People Living With Hiv ◽  
Transport Costs ◽  
Cross Sectional ◽  
East Central ◽  
Living With Hiv ◽  
Delivery Models ◽  
Art Delivery

Abstract Background The World Health Organization and Uganda Ministry of Health recommend differentiated service delivery models (DSDM) as patient-focussed approaches for delivering antiretroviral therapy for people living with HIV/AIDS (PLHIV) who have undetectable viral loads. We sought to determine the factors significantly associated with patient satisfaction with ART services amongst PLHIV enrolled in DSDMs. Methods This was a cross-sectional study of a random sample of PLHIVs accessing ART within DSDMs at nine facilities in East Central Uganda. Eligible patients were adult PLHIVs active on ART and enrolled in a DSDM (Community Client Led ART Delivery (CCLAD), Community Drug Distribution Points (CDDP) and Fast-Track Drug Refill (FTDR) models) for at-least twelve months. Data was collected over two months (June-July 2019). A validated tool was used to assess PLHIV satisfaction with service delivery in DSD. Logistic regression was used to establish factors associated with patient satisfaction with DSD services. Results Overall out of the 842 participants enrolled onto the study, 530(63.5%) accessed HIV care through CDDPs, 166(20.1%) through CCLAD, and 146 (16.3%) through FTDR DSDMs. Generally, 541 (64.2%) were satisfied with DSDM services : 78.7% in CDDP, 42.8% in CCLAD and 36.3% in CCLAD. The factors associated with patient satisfaction were being on CDDP [aOR = 3.42, 95% CI = 2.15–5.44] and FTDR[aOR = 2.92, 95% CI = 1.34–6.31] DSDMs relative to CCLAD, greater than three years on DSDM [aOR = 2.32, 95% CI = 1.12–4.87], lower transport costs (< $ 1.35) per clinic visit [aOR = 2.39, 95% CI = 1.59–3.60] being employed either in agriculture[aOR = 4.41, 95% CI = 2.62–7.41] or any other employment sector [aOR = 4.22, 95% CI = 2.46–7.27]relative to being unemployed, participation of a friend/relative [aOR = 1.79, 95% CI = 1.22–2.61] and not drinking alcohol [aOR = 2.33, 95% CI = 1.24–4.29]. Conclusions The study highlighted that 64.2% of the patients are satisfied with services in DSDM. Service delivery factors (DSDM model type, time spent in DSDM, and having friend or relative enrolled at the ART point providing social support), social factors (employment, and alcohol consumption), and transport costs were all associated with patient satisfaction with DSDM. Implementers of DSDMs need to further adapt services to address these factors to improve patient satisfaction in DSDMs.

scholarly journals Effect of Community ART Groups on retention-in-care among patients on ART in Tete Province, Mozambique: a cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016800 ◽  
Author(s):  
Tom Decroo ◽  
Barbara Telfer ◽  
Carla Das Dores ◽  
Richard A White ◽  
Natacha Dos Santos ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Facility ◽  
Cox Regression ◽  
Retention In Care ◽  
Sub Saharan Africa ◽  
Community Art ◽  
Loss To Follow Up ◽  
Individual Care ◽  
Sub Saharan ◽  
Delivery Models

ObjectivesEstimate the effect of participation in Community ART Groups (CAG) versus individual care on retention-in-care (RIC) on antiretroviral therapy (ART).DesignRetrospective cohort study.SettingHigh levels of attrition (death or loss-to-follow-up (LTFU) combined) on ART indicate that delivery models need to adapt in sub-Saharan Africa. In 2008, patients more than 6 months on ART began forming CAG, and took turns to collect ART refills at the health facility, in Tete Province, Mozambique,.Participants2406 adult patients, retained in care for at least 6 months after starting ART, during the study period (date of CAG introduction at the health facility—30 April 2012).MethodsData up to 30 April 2012 were collected from patient records at eight health facilities. Survival analysis was used to compare RIC among patients in CAG and patients in individual care, with joining a CAG treated as an irreversible time-dependent variable. Multivariable Cox regression was used to estimate the effect of CAG on RIC, adjusted for age, sex and health facility type and stratified by calendar cohort.Results12-month and 24-monthRIC from the time of eligibility were, respectively, 89.5% and 82.3% among patients in individual care and 99.1% and 97.5% among those in CAGs (p<0.0001). CAG members had a greater than fivefold reduction in risk of dying or being LTFU (adjusted HR: 0.18, 95% CI 0.11 to 0.29).ConclusionsAmong patients on ART, RIC was substantially better among those in CAGs than those in individual care. This study confirms that patient-driven ART distribution through CAGs results in higher RIC among patients who are stable on ART.

scholarly journals A mixed-methods evaluation of the uptake of novel differentiated ART delivery models in a national sample of health facilities in Uganda

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254214
Author(s):  
Henry Zakumumpa ◽  
Kimani Makobu ◽  
Wilbrod Ntawiha ◽  
Everd Maniple
Keyword(s):  
Mixed Methods ◽  
Fast Track ◽  
Drug Distribution ◽  
Health Facilities ◽  
Hiv Care ◽  
Adult Males ◽  
Community Based ◽  
For Profit ◽  
Delivery Models ◽  
Art Delivery

Introduction Since 2017, Uganda has been implementing five differentiated antiretroviral therapy (ART) delivery models to improve the quality of HIV care and to achieve health-system efficiencies. Community-based models include Community Client-Led ART Delivery and Community Drug Distribution Points. Facility-based models include Fast Track Drug Refill, Facility Based Group and Facility Based Individual Management. We set out to assess the extent of uptake of these ART delivery models and to describe barriers to uptake of either facility-based or community-based models. Methods Between December 2019 and February 2020, we conducted a mixed-methods study entailing a cross-sectional health facility survey (n = 116) and in-depth interviews (n = 16) with ART clinic managers in ten case-study facilities as well as six focus group discussions (56 participants) with patients enrolled in differentiated ART models. Facilities were selected based on the 10 geographic sub-regions of Uganda. Statistical analyses were performed in STATA (v13) while qualitative data were analysed by thematic approach. Results Most facilities 63 (57%) commenced implementation of differentiated ART delivery in 2018. Fast Track Drug Delivery was the most common facility-based model (implemented in 100 or 86% of health facilities). Community Client-Led ART Delivery was the most popular community model (63/116 or 54%). Community Drug Distribution Points had the lowest uptake with only 33 (24.88%) facilities implementing them. By ownership-type, for-profit facilities reported the lowest uptake of differentiated ART models. Barriers to enrolment in community-based models include HIV-related stigma and low enrolment of adult males in community models. Conclusion To the best of our knowledge this is the first study reporting national coverage of differentiated ART delivery models in Uganda. Overall, there has been a higher uptake of facility-based models. Interventions for enhancing the uptake of differentiated ART models in for-profit facilities are recommended.

scholarly journals Dispensing antiretrovirals during Covid-19 lockdown: re-discovering community-based ART delivery models in Uganda

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Henry Zakumumpa ◽  
Christopher Tumwine ◽  
Kiconco Milliam ◽  
Neil Spicer
Keyword(s):  
Health System ◽  
National Level ◽  
Hiv Care ◽  
District Health ◽  
Community Based ◽  
Community Based Art ◽  
System Resilience ◽  
Delivery Models ◽  
Art Delivery

Abstract Background The notion of health-system resilience has received little empirical attention in the current literature on the Covid-19 response. We set out to explore health-system resilience at the sub-national level in Uganda with regard to strategies for dispensing antiretrovirals during Covid-19 lockdown. Methods We conducted a qualitative case-study of eight districts purposively selected from Eastern and Western Uganda. Between June and September 2020, we conducted qualitative interviews with district health team leaders (n = 9), ART clinic managers (n = 36), representatives of PEPFAR implementing organizations (n = 6).In addition, six focus group discussions were held with recipients of HIV care (48 participants). Qualitative data were analyzed using thematic approach. Results Five broad strategies for distributing antiretrovirals during ‘lockdown’ emerged in our analysis: accelerating home-based delivery of antiretrovirals,; extending multi-month dispensing from three to six months for stable patients; leveraging the Community Drug Distribution Points (CDDPs) model for ART refill pick-ups at outreach sites in the community; increasing reliance on health information systems, including geospatial technologies, to support ART refill distribution in unmapped rural settings. District health teams reported leveraging Covid-19 outbreak response funding to deliver ART refills to homesteads in rural communities. Conclusion While Covid-19 ‘lockdown’ restrictions undoubtedly impeded access to facility-based HIV services, they revived interest by providers and demand by patients for community-based ART delivery models in case-study districts in Uganda.

Progress report on 21-cm observations at low latitude between longitudes (l 11) 0° and 66°

1967 ◽  
Vol 31 ◽  
pp. 177-179
Author(s):  
W. W. Shane
Keyword(s):  
Preliminary Report ◽  
Progress Report ◽  
Galactic Centre ◽  
Low Latitude ◽  
The Third ◽  
Introductory Lecture ◽  
Centre Region

In the course of several 21-cm observing programmes being carried out by the Leiden Observatory with the 25-meter telescope at Dwingeloo, a fairly complete, though inhomogeneous, survey of the regionl11= 0° to 66° at low galactic latitudes is becoming available. The essential data on this survey are presented in Table 1. Oort (1967) has given a preliminary report on the first and third investigations. The third is discussed briefly by Kerr in his introductory lecture on the galactic centre region (Paper 42). Burton (1966) has published provisional results of the fifth investigation, and I have discussed the sixth in Paper 19. All of the observations listed in the table have been completed, but we plan to extend investigation 3 to a much finer grid of positions.

The orbit of Pluto over a long interval of time

1966 ◽  
Vol 25 ◽  
pp. 227-229 ◽  
Author(s):  
D. Brouwer
Keyword(s):  
Periodic Orbit ◽  
Numerical Integration ◽  
Restricted Problem ◽  
Three Dimensional ◽  
The Third ◽  
Circular Restricted Problem ◽  
Resonance Relation

The paper presents a summary of the results obtained by C. J. Cohen and E. C. Hubbard, who established by numerical integration that a resonance relation exists between the orbits of Neptune and Pluto. The problem may be explored further by approximating the motion of Pluto by that of a particle with negligible mass in the three-dimensional (circular) restricted problem. The mass of Pluto and the eccentricity of Neptune's orbit are ignored in this approximation. Significant features of the problem appear to be the presence of two critical arguments and the possibility that the orbit may be related to a periodic orbit of the third kind.

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